Histoplasmosis Among Human Immunodeficiency Virus-Infected People in Europe: Influence Statistics

Expert Impact

Concepts for which they have has direct influence: Patients histoplasmosis , Human immunodeficiency virus , Human immunodeficiency , Immunodeficiency virus , Endemic areas , South america , Hivassociated histoplasmosis .

Key People For Patients Histoplasmosis

Top KOLs in the world
#1
Lawrence Joseph Wheat
disseminated histoplasmosis histoplasma capsulatum antigen detection
#2
Carol A Kauffman
fungal infections zoster vaccine endemic mycoses
#3
David S McKinsey
fluconazole therapy hiv treatment histoplasmosis patients
#4
Patricia A Connolly
histoplasma capsulatum disseminated histoplasmosis antigen detection
#5
James E Loyd
pulmonary hypertension bmpr2 mutation mediastinal fibrosis
#6
Chadi A Hage
lung transplantation bronchoalveolar lavage fungal infections

Histoplasmosis Among Human Immunodeficiency Virus-Infected People in Europe

Abstract

. We reviewed the clinical, microbiologic, and outcome characteristics of 72 patients with human immunodeficiency virus (HIV)-associated histoplasmosis (4 newly described) reported in Europe over 20 years (1984-2004). Seven cases (9.7%) were acquired in Europe (autochthonous), whereas the majority involved a history of travel or arrival from endemic areas. The diagnosis of progressive disseminated histoplasmosis (PDH) was made during life in 63 patients (87.5%) and was the acquired immunodeficiency syndrome (AIDS)-presenting illness in 44 (61.1%). Disease was widespread in 66 patients (91.7%) and localized in 6 (8.3%), with the skin being the most frequent site of localized infection. Overall skin involvement was reported in 47.2% of the patients regardless of whether histoplasmosis was acquired in Africa or South America. Reticulonodular or diffuse interstial infiltrates occurred in 52.8%. The diagnosis was made during life by histopathology plus culture in 44 patients (69.8%), histopathology alone in 18 (28.5%), and culture alone in 1 (1.5%). During the induction phase amphotericin B and itraconazole (74.6%) were the single most frequently used drugs. Both drugs were also used either in combination (10.2%) or in sequential therapy (11.8%). Cumulative mortality rate during the induction phase of treatment was 15.2%. Overall, 37 patients died (57.8%); death occurred early in the course in 18 (28.1%). Seven of 40 patients (17.5%) who responded to therapy subsequently relapsed. Autopsy data in 13 patients confirmed the widespread disseminated nature of histoplasmosis (85%) among AIDS patients with a median of 4.5 organs involved. The results of the present report highlight the need to consider the diagnosis of PDH among patients with AIDS in Europe presenting with a febrile illness who have traveled to or who originated from an endemic area.